Giving Birth

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Department of Sociology

Master Thesis in Sociology, 30 credits Spring Term 2014

Advisor: Vanessa Barker

Giving Birth

Debating Surrogate Motherhood in Sweden, A

Question of Equality

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Abstract

The purpose of this study has been to identify, analyze and interpret the framing and meaning of the surrogacy debate in Sweden. The study is built on a textual analysis of statements produced within the political sphere on the topic (2001-2012), as well as within other public contexts by actors such as interest groups, different debaters and newspaper editorials (2010-2014).

Core conflicts revolve around equality, and the tension between women’s and children’s rights, high priorities in the Swedish context, and the emergence of new family constellations, including gay couples. The other central issue regards human value and women’s right to bodily integrity or autonomy, as well as questions relating to private and public spheres: what can be – or ought not to be – given or sold.

Different frameworks have been dominant in the discussion to state a particular opinion. Those in favor of surrogacy often emphasize the importance of being open and modern, and pragmatic rather than ideological. In contrast, Feminist and Christian frames emphasize the risk of exploitation, as do those who from an inequality-perspective point to the act’s connection to – apart from gender – class and ethnicity.

Overall, the child’s perspective has been important and there has been a strong stance against commercial surrogacy, spanning different frameworks. Giving birth, rather than selling, is thus generally seen as the ethically correct alternative, if surrogacy is to be allowed.

Keywords

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1. Introduction

The topic of surrogacy has, in a few years’ time, gone from nonexistent in Swedish media to being widely discussed. The public debate spurred up around 2010 when the book Varat och

varan: prostitution, surrogatmödraskap och den delade människan (2010)1 by feminist Kajsa Ekis Ekman was published. It declared a strong and aggressive stance against all forms of surrogacy agreements, comparing it to prostitution and human trade. Not everyone agreed with these opinions, and politicians had a few years earlier begun to argue that surrogacy out of altruistic motivations ought to be considered. In 2012 it was decided by a majority of the Riksdag that an impartial investigation should be made whether to allow these arrangements in Sweden. The majority of the Swedish National Council on Medical Ethics (SMER)2 came to the conclusion that an altruistic form ought to be allowed. Influenced by the council’s recommendation, the investigation for possible implementation of this alternative is currently taking place at the Ministry of Justice3 and is to be finished in June 2015 at the latest. These recent activities are thus indicating that the long-term restriction might become overturned, making it a sociologically relevant and socially important case to study. As will be shown, the debate also relates to longstanding issues within sociology such as the interconnection between public spheres; the market and the state, and more private spheres; family.

Surrogacy has raised controversy all over the globe (Inhorn & Birenbaum-Carmeli 2008) and can be discussed from an array of different perspectives: from the viewpoint of the child born through surrogacy; the surrogate mother’s; the intended parents; the potential donors of genetic material; fertility clinics and other involved actors; and more broadly from legal, psychological, ethical, cultural, political and economic perspectives. A lot of research is still yet to be done, partly because the practice is a relatively new phenomenon. More studies are needed that analyze the cultural values that surrogacy becomes intertwined with in different national contexts and the impact these attitudes and beliefs have on various legislative outcomes (Ciccarelli & Beckman 2005: 39). This paper partly falls within this area of research. Neither has much been written on the topic in Sweden: consequently the study also adds to this scarcity.

1_{Published in English by title Being and being bought: prostitution, surrogacy and the split self (2013).} 2_{Statens medicinsk-etiska råd.}

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1.1 Purpose and research questions

The purpose of this study is to identify, analyze and interpret the framing and meaning of the surrogacy debate in Sweden. The following research questions have been constructed:

• How has surrogacy been framed in the political and public debate? • Have some frameworks been more dominant than others and if so, why? • Do any core conflicts emerge from the debate?

1.2 Limitation of study

Firstly, as interesting as it would be to speculate on the coming legislative outcome based on the ideas expressed in the public debate, it falls outside the scope of this study. Based on this research I will not be able to draw any causal links between the discourses or ideas expressed in the debate and the political decision. It is neither so that dominating beliefs about what is right necessarily decide the final verdict, nor that they conquer over other social processes involved in change. Secondly, the paper does not take a stand on surrogate motherhood.

1.3 Outline of paper

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2. Background

Indeed, [assisted reproductive technologies] are a key symbol of our times, representing the growing prominence of biotechnologies in the configuration of individual, familial, and collective identities around the globe. (Inhorn & Birenbaum-Carmeli 2008: 177)

2.1 What is surrogacy?

In 1978, Louise Brown, the world’s first ”test-tube” baby was born in England from in vitro fertilization (IVF)4. Another method soon to be expanding and be made aware to the public was surrogacy. A surrogate mother is someone who carries a child on behalf of someone else.

Traditional5 surrogacy implies that the surrogate is the genetic mother and has been practiced since ancient times. In much academic literature on the topic, references are often made to Biblical stories in which women unable to bear children “sent their husbands to their maids”. However, it was not until the development of artificial insemination (AI) that conception could occur without sexual relations. This method led to the development of a surrogacy market in the U.S. in the beginning of the 1980’s. Through the development of IVF, also

gestational6_{surrogacy was made possible, which implies that the surrogate mother is not}

genetically related to the child she carries. Eggs and sperm can be either the intended parent(s) or donated from third parties (Spar 2006). Debora L. Spar who has written the book

The Baby Business: How Money, Science and Politics Drive the Commerce of Conception

(2006) describes how this development “revolutionized the business” as a consequence of “splitting the baby-making process into three fully separate components” (ibid.: 78). The gestational surrogate did no longer need a good genetic set-up often deemed important in the traditional form, but what mattered was the ability to keep a healthy lifestyle during pregnancy. This allowed for a greater supply of surrogates, as did the fact that women did not have to carry and give up their genetic child. The supply of egg donors also increased as there were groups of women now willing to donate eggs but not undergo a pregnancy (ibid.: 79-80). In later years, the public has been made aware of the development of an increasing “reproductive tourism” to countries such as India, where Indian women give birth to children

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sprung from eggs and sperm originating from different parts of the world. What the debate has come to revolve around in later years is the gestational form, which is also what this paper deals with.

Surrogacy is a consequence of the longing for children and the market needs to be understood as an outcome of this demand. Around 10-15 percent of those couples wanting children are affected by infertility (SMER 2013: 28). Groups presently lacking access to infertility treatment in Sweden are couples where both parties experience infertility problem; women with uterine malfunctions; gay male couples; single women7; and single men (ibid.: 100). For some of these groups surrogacy has served as a solution and The National Board of Health and Welfare8 has estimated that around 100 children have arrived in Sweden the last few years after having been born through surrogacy abroad (Sveriges Radio 2013).

2.2 Legislation in Sweden and abroad

The difference between altruistic and commercial surrogacy plays an important role in the global legislation. Briefly explained, the former implies that the surrogate mother only receives compensation for the expenses related to the pregnancy. The latter implies that the host mother is apart from receiving compensation also paid for the service itself, often by previously unknown recipient(s). Examples of where altruistic surrogacy is possible are Great Britain and the Netherlands. Examples of where commercial surrogacy is possible are India, Ukraine and parts of the U.S. (SMER 2013: 156). Surrogacy is not allowed in the Scandinavian countries, not always banned by a law specifically aimed at the practice, but other laws prevent it. Finland used to allow the altruistic form, but not since 2007 (ibid.: 161-162). Many countries lack or have an unclear legislation, and considering the global character of the practice, several with knowledge of the field have started to argue in favor of a globalized solution (see e.g. Spar 2006; Pande 2012).

Many countries have set up national commissions to study different aspects of the controversial practice, whose reports later have been used as guidelines for implementation of legislation (Markens 2007: 23). This is a good example of how it has been processed in Sweden. In 1995 SMER issued a report on assisted reproduction that argued that the practice could contravene the human right’s principle, människovärdesprincipen, as ”the woman who

7_{It has recently been recommended that single women should get access to insemination in Sweden from the 1st}

of July 2015 (Justitiedepartementets delbetänkande SOU 2014:29).

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goes through the pregnancy at least initially is used as a means to solve the childless couple’s problem” (SMER 1995: 35, my translation). What was also emphasized were the difficult conflicts that can arise over the rights to the child, with court cases in the U.S. taken as examples9, as well as how it could open up for a commercialization of the emergence of life. The Ministry of Health and Social Affairs published a memorandum10 in 2000 on the topic and stated that they agreed with SMER on not allowing surrogacy (2000:51, p. 49-50), and in the 2001 Government Bill on the treatment of infertility11 they took a stance stricter than SMER’s by stating that the practice contravened the human right’s principle, and not just that it could do so (Stoll 2013: 57). There is no legislation banning surrogacy, but in the same bill it was proposed that a new paragraph on motherhood in ”Föräldrabalken” should be introduced stating that ”if a woman gives birth to a child who has come to life through the inserting into the woman’s body an egg from another woman which has been conceived outside of the body, she shall be regarded as the child's mother” (Proposition 2001:02-89, p. 6, my translation). The law came into force January 1st 2003 (Socialutskottets betänkande 2001/02:SoU16) and simply means that the birth mother is always the legal mother, thereby protecting women who have received donated eggs (Stoll 2013: 324) and preventing surrogacy. It also follows from regulations on “insemination” and “conception outside the body” (6-7 kap. Lagen om genetisk integritet) that it should not be practiced within healthcare.

In the beginning of the 2000’s there was a general resistance towards allowing surrogacy and no public opinion in favor of legalization (Jönsson 2003: 66). However, during the past decade, particularly the later part, private members’ bills, motioner, have been issued arguing that surrogacy ought to be investigated more thoroughly and in 2012 it was decided that an unprejudiced investigation should be made, with the only parties being against were the Christian Democrats (KD) and the Left Party (V)12 (Socialutskottets betänkande 2011/12:SoU26). The Swedish National Council on Medical Ethics had already begun to evaluate the question from an ethical perspective and this time reached the conclusion that

altruistic surrogacy ought to be allowed (SMER 2013). In the days and weeks after their

statement the Swedish public debate on the topic was greater than ever before, which this

9_{E.g. the infamous Baby M Case which took place in the U.S. in the end of the 80's, in which the surrogate}

mother who had been inseminated with the sperm of the father of the contracting couple changed her mind about giving up her genetically related child after birth (see e.g. Markens 2007).

10_{Socialdepartementets promemoria 2000:51.} 11_{Proposition 2001:02-89.}

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3. Theoretical framework and

previous research

In this section I will discuss how surrogate motherhood has been conceptualized in previous research and theory. The first section (3.1) gives an introduction to how we can understand social problems and conflicts in general, whereas the others sections (3.2-3.5) present topics related to surrogacy, often expressing different understandings that I will return to in the analysis. The controversies surrounding surrogacy have been described in different ways in academia. For example, a study that this paper shares similarities with looked at public responses in the U.S., and described them “as a publicly perceived social problem” (Markens 2007: 9). I will also use this concept in the text in order to point to the conflicts that surround the practice, without judging the practice itself as a social problem.

3.1 Social conflicts and problems: The battle of

values, interests and classification schemes

Some of the conditions we consider to be social problems were not so considered in earlier times. And some of the things our grandparents saw as social problems are accepted without question today (…). And there are probably some things, that, regardless of their troublesome nature, never have been and never will be considered to be social problems. (Rubington & Weinberg 2011: 3)

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understand, compared to previous times when people lived their lives in more similar ways. However, at times an entire (modern) society becomes aware of the fact that its basic constituents are changing or being threatened. As in the case of surrogacy. Reproduction simply touches upon core practices and values in a society that overrides the fact that it involves fewer people than many other issues that could be argued to deserve as much attention, but which pass without notice.

There are different ways within sociology of understanding how social problems or conflicts are born. Many have emphasized the impact of opposing values and interests of different groups (Rubington & Weinberg 2011: 98). In a seminal paper, sociologists Richard C. Fuller and Richard R. Myers argued that social problems go through the natural stages of awareness, policy determination, and reform (1941). Although this has been criticized as a simplification (Lemert 1951), it illuminates parts involved in the process. Herbert Blumer instead emphasized the different activities that actors engage in – the collective behavior – to create awareness of a specific problem: the “role of agitation in getting recognition for a problem”; the role of different interest groups, political figures and “powerful organizations and corporations” in illuminating particular dimensions of the problem and discourage others; the neglect of the perspectives of “powerless groups”; and finally, “the role of the mass media in selecting social problems; and the influence of adventitious happenings that shock public sensitivities” (1971: 302). Different national contexts consist of different actors. There are of course more actors with interests in the continuance of surrogacy where clinics are already established and money is being made. Here, a range of different professionals have become involved in the service (Gupta 2006: 31-32) and in many countries national policies are often intertwined with these interests (Donchin 2010: 326) Therefore, one could argue that once something profitable has been allowed, it is harder to make it illegal. As surrogacy is allowed in some countries but not in others, it causes people longing for children to cross borders and bring children born through this method back to countries where it is not allowed. Consequences of these situations are part of creating awareness for a specific problem and calling for action.

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this”. Classification systems are culturally tied, so what is seen as problematic in one context might not be so in another: as in the case of social problems. However, Marcia C. Inhorn and Daphna Birenbaum-Carmeli (2008) who have written a review over anthropological work on assisted reproductive technologies conclude that ”assisted reproduction has diversified, globalized, and denaturalized the taken-for-granted binaries of, inter alia, sex/procreation, nature/culture, gift/commodity, informal/formal labor, biology/sociality, heterosexuality/ homosexuality, local/global, secular/sacred, and human/nonhuman” (ibid.: 178). In other words, the practice has crossed many cultural barriers and raises ethical issues in almost all countries (Pande 2009).

In Western societies there has long existed a division between private and public spheres, also reflected in much scholarly work. Different expressions and motives are seen as more appropriate in one sphere than the other: e.g. the view that love and affection is supposed to be the guiding principle in intimate relationships and not money and calculated rationality (Zelizer 2005). The separation of gifts and commodities, reciprocity and market exchange, go a long way back in much theoretical writing. Arjun Appadurai has, in the well-cited book The

Social Life of Things: Commodities in a Cultural Perspective (1986), argued that these

dichotomies – gifts as signs of reciprocity and commodities as sprung from self-interest – are simplifications. The former can also be guided by a calculative spirit and the latter are, just like gifts, embedded in cultural contexts and social relationships (ibid.: 11-12). This reasoning partly builds on Marcel Mauss’ ideas expressed in the classic The Gift: Forms and Functions

of Exchange (1925), which emphasized how gifts are not only about altruism but can also be

used to build relationships with expectations to gain something in return, or to establish hierarchies. In more recent decades, sociologists have tried to show how economics (traditionally understood mainly through theories of self-interest) and social relationships are intertwined and not opposites (see e.g. Granovetter 1985, Zelizer 2007).

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Sharyn Roach Anleu explains that understandings of surrogacy:

involve[s] the application of pervasive gender norms specifying that women's motivations to have children should be based on emotion, selflessness, and caring, not on self-interest, financial incentives, or pragmatism. Applying these norms renders commercial surrogacy deviant, but altruistic arrangements more acceptable. (1992: 30)

Altruistic forms keep the act within more private realms, thereby avoiding turning it into an anomaly. Even when women are being paid for becoming surrogates or providing eggs they emphasize their motivations to be altruistic (Teman 2010; Ragoné 1994; Haylett 2012, Almeling 2011). However, Rene Almeling (2011) has shown in a study of the U.S. medical market for eggs and sperm that while donation programs are active in constructing women’s paid donations as gifts, men’s are more constructed like a job. Thus, it is more accepted that men’s motivations might be economic: they do not have to cross the same cultural barriers.

3.2 What is a mother?

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(Pande 2009: 146).

In the case of transnational surrogacy, postmodern reproductive processes enable bodies to be fragmented into movable parts (eggs and sperm that are moved from one body to another); yet through legislative and cultural processes, these often are made to appear controlled and whole. (Kroløkke 2012: 312)

However, as the global fertility travel has increased it has become evident how different legislations clash, simultaneously as different understandings of motherhood are revealed. A case that can serve as an illustration and which received much attention in the media in Norway was when single, and 42-year old Kari Ann Volden hired a surrogate in India, and the twins born were not allowed Norwegian citizenship. To strengthen her case, Volden first stated she was the genetic mother, thereby normalizing her position within accepted Norwegian understandings of motherhood13. When it was later revealed that Volden was not the one who had donated the eggs, and therefore lacked a genetic connection to the children, the authorities rejected the application. What was then referred to by herself and support groups were the social aspects of motherhood, that what mattered was her love and nurturance of the twins and her obligation as the sole provider: something that is not recognized by the Norwegian state as constituting motherhood in these circumstances. In the end, Volden was allowed coming to Norway with the twins by a special stipulation (Andersen 2013: 42-46). Similar legal complications are common in Sweden, which currently lacks specific regulation to establish parenthood to children born through surrogacy. Presently it is instead done through adoption (Stoll 2013: 49).

Not all accept the views of motherhood as something constructed. Some feminist theorists, like Barbara Katz Rothman, argue that motherhood is established through pregnancy, period. That is, every woman carries her own fetus no matter whose the genetic material is (2008: 265). This would be to speak against the more postmodern view of motherhood as something fragmented and flexible. Katz Rothman has expressed how surrogacy is rooted in old patriarchal ideology that deprives women of their labor, including their children (1988: 21). Opening up for this practice, she argues, poses ”(…) an enormous threat to further constrain all pregnant women (if any woman is pregnant with a baby not her own, all women can be seen to carry babies for their fathers, the state, and others)(…)” (2008: 266).

13_{In comparison to Sweden Norway does not allow egg donation, thereby keeping genes and blood}

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3.3 Changing

structures

and

values:

understanding

contemporary

families

and

individuals

Independent of how one values the development of motherhood, it is a fact that it has become less self-evident. The same can be said about family life and the modern individual.

And the old assurances of ‘knowing your place’ in the world are replaced by a new self-reflexivity in which individuals must now actively work at constructing their identities through the project of the ‘self’. (Chambers 2012: 37)

What Deborah Chambers is referring to is Anthony Giddens’ well-cited concept of the reflexive-self, entangled with a society made up of less overarching authorities and more alternatives to how to live one’s life (Giddens 1991). In a similar vein, Elisabeth Beck-Gernsheim and Ulrich Beck (2002) talk about the rise of individualism, and how it, especially for women, has implied a change from ascribed to acquired roles and not only living for others, but also having a life of one’s own. What these theories have in common is an emphasis on today’s importance of self-fulfillment, something that is also regarded important to attain from intimate relationships.

The structural changes in family patterns seen on a macro-level over the past few decades are often termed The Second Demographic Transition (Mills & Blossfeld 2013). Relevant to this paper, it involves new ways of living together: changing gender roles (Goldscheider et al 2010); less permanent partnerships (Bernhardt 2004); there are more “blended” families of stepparents and stepchildren; and there has been an increase in same-sex couples living together (Chambers 2012: 52). Even if it has become more apparent that ”family and kinship are social creations and not products of biology” (Fox & Luxton 2001: 24), reproduction has for a long time been part of (re)producing the nuclear family pattern and it is not controversial to say that it is still a strong norm and reality for many. New reproductive techniques have been part of changing the past postulate of a sexual union between a woman and a man for the creation of a child. However, many still prefer using their own genetic material in the making: a preference that is, not surprisingly, one of the primary motivations for couples pursuing surrogacy (Ragone 1996: 358). Thus, new reproductive techniques both reproduce and challenge notions of family.

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Social Value of Children (1985) Viviana Zelizer showed how children up for adoption went

from being primarily economically valued to obtaining a sentimental value at the end and turn of 19th century America. For long the demand had been greater for children who were older and able to work than for smaller children, but with the shifting value it became less about taking “(…) a child for what you can get out of him” and more about “what you can put into him” (1988: 24) and infants thus became more popular. Today, the decision to have children has been understood as integrated with modern self-expressions (Mills & Blossfeld 2013). Nonetheless, the ability for self-expression needs to be understood as connected to having the resources to consume different lifestyles. Therefore, the theories of the modern self and her relationships have partly been criticized for neglecting a social class perspective as they often relate to the situation of the middle-class (Chambers 2012: 40). To illustrate, a study carried out in Sweden showed that working class and middle class fathers experienced the transition to fatherhood differently. For the former it was more of a natural process while for the latter it meant an active choice that was viewed as transformative to the personality, described as: “an opportunity to develop their identity and to get to know new sides of themselves” (Plantin 2007: 93). However, regardless of the differences that exist “out there”, ideas of the modern family life are popular in political and other public debates and shape current understandings (Chambers 2012: 40) and from a global perspective there are more well-off people using reproductive services than less privileged, indicating that these theories are applicable to this group.

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infertile citizens in the quest for children. When not being granted the parental rights she argues to deserve as a woman with difficulty conceiving, and as a good mother, she puts herself in the role of a victim to the state (2013: 44-45).

Along with the other Nordic countries, Sweden has been argued to be the forerunner of family matters, or the least traditional (Andersson et al 2006; Kaufmann 2002: 468). In referring to Hernes (1987) and Carbin et al (2011) Andersen writes: ”(…) political resistance and progressive social movements connected to gender and sexuality in the Nordic area have a history of becoming incorporated into the system, into the Socialdemocratic welfare state” (2013: 53, my translation). In Sweden, much political as well as scientific work has over the past half century collaborated to encourage fathers’ active relationships to their children, reducing the difference between mother- and fatherhood, as well as questioning the division made between women and men, and female and male attributes (see discussion in Olsson 2011: 355-362). As Hellgren & Hobson point out “(…) gender equality has become a marker of the Swedish state identity (…)” (2008: 386). Sweden has also placed a firm emphasis on the protection and “quality” of children, expressed in e.g. “being the first country to forbid corporal punishment of children” (Kaufmann 2002: 468-470).

3.4 Debating unequal circumstances: exploitation

or denied self-determination?

The following two sections (3.4 and 3.5) deal more specifically with what have been raised as problems in relation to surrogacy in previous research.

Richard Titmuss, in writing about donations of blood in The Gift Relationship: From Human

Blood to Social Policy (1971), compared England and the U.K. and argued that a system

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surrogacy has, from a Marxist perspective, been understood as inviting to an establishment of a "reproductive proletariat" (see discussion in Jönsson 2003: 165), where poor women make up the willing sellers (Radin 1996). Transnational surrogacy has been discussed through these aspects: how rich people in affluent countries use poor people in developing countries (Donchin 2010: 323); how it reproduces a colonial practice (Kroløkke 2012: 311; Donchin 2010: 329); and as a type of ”reproductive trafficking”, or control over women’s bodies by others than themselves (Corea 1985; Raymond 1993). ”Within global capitalism women’s cheap labour is not only used to produce for the world market, but also to ’reproduce’ for the world market” (Gupta 2006: 32). Surrogacy needs to be viewed from an intersectional perspective: although it is a question clearly relating to gender, it does not mean that all women share the same interests and experiences (see discussion in Markens 2012: 1746-1747). For well-off women it has opened up a new form of reproductive control and freedom while simultaneously implying ”outside control and expropriation” for less advantaged women (Gupta 2006: 28). Women partake both as buyers and sellers (ibid.: 31), but the roles are not interchangeable between groups, as the former is in general more well-off than the latter.

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surrogatmödraskapet14_{(2003), one of the few Swedish academic literatures on surrogacy. He}

challenges the Swedish legal prohibition arguing that it cannot be morally justified. In a liberal democratic society every adult member should have the ”(…) right to decide what to do with his or her body without state interference, as long as the actions do not interfere with the equal rights of others” (ibid.: 232). By others it has been raised that some rights are inalienable, i.e. some things should not be possible to sell. For example, one is not allowed to sell oneself as a slave even though there might be consent over this between involved parties. Philosopher David Ellerman (2010) has stated that consent throughout history has been used to legitimize the relationship between the superior and the subordinated. The same argument could be raised in relation to surrogacy, i.e. although there is consent between the parties over the contract, it should not be possible to sell one’s reproductive labor. Donchin writes: ”It is understandable that impoverished women in poor economies may accept offers to sell their bodily resources rather than sink further into poverty, but their consent can’t turn a morally unacceptable offer into a morally fair purchase” (2010: 325).

3.5 Commodification: discussing exploitation of

humanity and presenting counterarguments

Arguments against paid exchange in social relationships often lead to a discussion of

commodification. Overall, it deals with the "intrusion" of the economy into social spheres

seen to ought to be guided according to other principles than market values, where theorists raise questions such as “what happens to the kinds of traditional reciprocal relationships that are born of affection, love, and devotion?” (Rifkin 2000: 112). Elizabeth S. Anderson argues in a well-cited article about commercial surrogacy that women are degraded if their pregnancy is treated as a commodity (1990: 75). From this perspective, surrogacy becomes exploitative in itself and not solely because of the unequal circumstances that surround it, as described earlier. Lesley Sharp (2000), who has written an extensive article on commodification of the body, explains how it transforms “(…) persons and their bodies from a human category into objects of economic desire” and continues “Thus, the presence of objectification in a host of forms is significant because it flags the possibility that commodification has occurred (…)” (ibid.: 293). It implies the reduction of people to solely their potential as an object within a particular context. In Marx's (1867) classical understanding, in the context of capitalism, it

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would imply being reduced to a mere cog in a working-wheel, a subjectivity which goes against human beings' creation of themselves through their being in the world. However, people are not only commodified in the name of profit. The weaker part in social relationships can be exploited, and in a patriarchal context "(…) women's bodies are fragmented in a host of ways, through their reproductive potential, so that they are reduced to vaginas, wombs, or breasts" (Sharp 2000: 294): aspects that have been raised as arguments against altruistic surrogacy.

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4. Methodology

In this section I will discuss the used material: why this type of material was chosen, how it was accessed and selected, and finally how the textual analysis was carried out. I will also briefly discuss ethical considerations.

4.1 What material to use and why?

This study falls within the qualitative field. To capture the range of ideas expressed in relation to surrogacy, I chose to examine the political and public debate on the topic. What have been analyzed are political documents consisting of private members’ bills (motioner), reports, and one debate; as well as newspaper editorials, debate articles and statements made on websites by various interest groups. Susan Markens has written the book Surrogate Motherhood and

the Politics of Reproduction (2007) where one section is an analysis of part of the American

debate on surrogacy that took place during the late 1980’s and early 1990’s. She points out that ”newspapers (…) play an important role in shaping the views and behavior of public officials and other activists" (ibid.:186). The surrogacy debate in Sweden which has taken place in media the last few years, is to a great extent, a response to what is happening in politics, therefore these two spheres need to be understood as being in dialogue with one another. So, what does this kind of material tell us? Not necessarily what other parts of the community believe. However, speaking from positions of power, it could be argued that the ideas expressed have an influence on public opinion. It is thus an interesting material to study as well as being sociologically relevant.

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4.2 Access and selection

To gain access to political documents, I searched the Riksdag’s website. A collection was made of all private members’ bills, on the topic issued between the years 2001-2012, i.e. from the year when the first was issued until the year when it was decided that surrogacy should be investigated. I also collected other political reports: most of which were published over the same period as the motions. All the material was sorted into Scrivener, a writing and draft software, divided by year so I would get a clear understanding of the development of the process. What was selected for the analysis, apart from different private members’ bills (most from 2008 and later), were Socialutskottets betänkande 2011/12:SoU26, Protokoll 2011/12:91 (debate over the proposal in 2012), and Report 2013:1 by SMER.

Compared to e.g. the U.S. where discussions on surrogacy in the media were the largest in the end of the 80’s beginning of the 90’s (Ciccarelli & Beckman 2005, Markens 2007), the attention given to the topic in Sweden was almost nonexistent up until a few years ago. The same year Kajsa Ekis Ekman’s book (2010) was released, there was a steady increase in articles on the topic compared to previous years and I therefore chose this as the starting year: deciding to analyze articles published between 2010-2013. In order to gain access to the newspaper articles I have used the database Mediearkivet, the largest digital news-archive among the Nordic countries (Retriever 2014). I have gone through all articles published during the period in 657 sources (Swedish printed press) that are accessible through the database by the search terms surrogatmödraskap or surrogatmoderskap or värdmödraskap or

värdmoderskap15. The search resulted in 452 hits in 2013; 316 hits in 2012; 200 hits in 2011; and 149 hits in 2010. On account of my main interest to analyze what participating debaters have to say about the practice as such, I believe to have gained access to most of the relevant material by the used search terms. Terms such as surrogat and surrogatmamma16 resulted more often in articles that were focused on telling personal stories. These would of course have been interesting to analyze as well, but fall outside the realm. Some journals are not included in Mediearkivet. Therefore, a kind of ”snowball technique” has been applied: if someone has referred to an article I have not gained access to through Mediearkivet I have looked it up separately. However, it is impossible to access (moreover to analyze) everything published on the topic, but after going through the material I believe saturation has been reached.

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The selection of newspaper articles was conducted in the following way: all editorials published on the topic have been selected as well as all debate articles, except for those written by anonymous debaters or private persons just having an opinion without stating anything about themselves or what their relationship is to the practice. The reason for this is that part of my interest is in who says what. The analyzed articles are those that clearly express an opinion, more “neutral” ones like ”She gave birth to a surrogate child” that turned up in the search have not been analyzed. I have gone through interviews made with participating debaters, but only selected texts written by the debaters themselves. I have also looked at involved organizations that have made public statements regarding their stance on e.g. their website17. All of the relevant texts were sorted – based on the above criteria – into Scrivener, in the same way as I did for the political documents. General news and recurring stories were sorted in another section, just to keep track of what was happening in general on the topic during each year.

I have also watched and listened to news and debates which have taken place on TV and radio. I participated in a meeting arranged by The National Swedish Association for Sexual Information (RFSU18) in the end of January on the topic, where a panel discussion took place between the president of RFSU: Kristina Ljungros, and the chairman of The Swedish Women’s Lobby19: Gertrud Åström. The latter being against an introduction of the practice in Sweden, and the former ”carefully positive”, försiktigt positiv. These extra activities have given a good overview of the field and the participating actors.

4.3 Coding and analysis

In the start-up of the analysis I was interested in seeing how some themes from the theoretical framework were expressed in the debate. However, considering one of my research questions has been how surrogacy is framed in the debate, I did not want to limit the analysis to what John Creswell calls prefigured categories (2007: 152), which constrains the analysis to aspects to a great extent already known. Rather, emergent categories led to the expansion and change of the initial theoretical framework. First I read through all the articles and coded them according to main issues being brought up, e.g. “children is no right”, “women’s right to choose” etc, which helped to gain an understanding of which themes have been dominant and what have been marginal. Although counting belongs in a more quantitative context, it has

17_{Referred to by (2014) if the statement does not include a date.} 18_{Riksförbundet för sexuell upplysning.}

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still been important to pay attention to recurring statements.

Considering the large amount of material, I did not conduct e.g. a thorough discourse analysis, but have rather, in relation to the research questions, conducted a textual analysis in which I looked at different understandings of the main themes that came out of the analysis: e.g. of motherhood and family, of differences in viewing the act as either exploitative or altruistic, etc. In other words, I have to a great extent used in vivo codes (Creswell 2007: 153), i.e. used the same terms as the debaters. In the end I analyzed how these different types of understandings lead to conflicts – reconnecting to the theoretical section on how social conflicts or problems are formed, on what grounds, and which frames have been able to gain more recognition than others.

4.4. Ethics:

the

researcher’s

impact

and

responsibility

From a qualitative point of view, “all research is interpretive: guided by a set of beliefs and feelings about the world and how it should be understood and studied” (Denzin & Lincoln 2011:13). If one believes that there are several ways of telling a story and that this also applies to science, what becomes important is to tell about the tools one has used in the analysis. The researcher will focus on different aspects depending on the research question and the theoretical framing. This means that the story could have been told in another way. My aim, however, has been to examine the material in an open and systematic way while being

transparent about how the collection and analysis have been carried out. Although no human

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5. Analysis & Results

Aspects raised in both the political and public debate are the difficulties experienced by couples who want children, but who cannot get them without assistance. This longing is the reason why surrogacy is investigated in the first place – maybe evident, but considering all the different actors and ideas surrogacy becomes intertwined with, it warrants a repeating. The social problem of infertility has thus not been explored to a great extent in this analysis, but I have rather considered what ideas it runs up against. Neither have I analyzed all the different legal issues discussed, nor the little research on the well-being of actors involved that is being referred to by debaters – either to state their case, or by criticizing the studies as problematic for different reasons.

Sections 5.1 & 5.2 are thematically presented, i.e. according to the two general themes of

family and unequal circumstances, commodification, and self-determination. The subsections

are presented according to a dialectic or dialogic outline (see e.g. Jarrick & Josephson 1996), i.e. by showing the disagreements on particular topics, which partly builds on the themes presented in the theoretical framework. I have separated the political discussions from those carried out in other public arenas, simply naming participants in the former politicians and participants in the latter debaters. It should be pointed out that views can of course differ within parties, as an example: members of the Left Party were the first to issue a private member’s bill calling for an investigation of surrogacy, but the party as a whole was a little more than a decade later against an investigation.

5.1 Debating family

In this section, I will highlight what is being debated in relation to family in general, children, childless adults, and mothers.

5.1.1 Political discussions on the rights of children and adults

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children who we create good conditions for in Sweden. (Barbro Westerholm (FP) Protokoll 2011/12:91)20

Over the years a recurring statement has been that children born through this method exist in Sweden and face several legislative problems, together with their parents. Not granting them equal rights as other children is seen as problematic (e.g. Christin Hagberg, The Social Democratic Party (S)21, Protokoll 2011/12:91). As Barbro Westerholm and Birgitta Ohlsson of the Liberal Party (FP)22 have argued: “the question has to be investigated, not swept under the rug” (Motion 2008/09: So222). On the contrary, politicians from the Christian Democrats (KD) have not focused on the children born through surrogacy, but instead on the rights perspective of children in general23. Surrogacy is criticized for being a solution to the wishes of adults and an argument has been that ”the claims of adults need to be denied (…) from the rights perspective of the child” (Kjell Eldensjö (KD), Motion 2009/10:So563). This right is often connected to growing up in a nuclear family consisting of biological parents of opposite sex. Eldensjö writes:

The notion that the child is best off growing up in an intact relation to both its mother and father is further a notion that goes deep into our society. Not less than 87 percent of the Swedish people believe that children have a fundamental right as far as possible to grow up with their biological parents (SIFO 2007). (…) It is neither so that the social parents’ sex is insignificant, even if that sort of a theory exist within e.g. the academic world. It is not a proven fact, even if the theory sometimes is driven in an opinion forming and ideological way as if it were. (Motion 2009/10:So56324₎

The statement resonates well with the concept of “people of the reality”, verklighetens folk, used by party leader Göran Hägglund (KD) to describe the reality of what he sees as the “common people”, located far away from the values and ideas of the cultural elite (DN 2009). In comparison to representatives of the other parties who generally express that caring and love are what matter for the well-being of the child and not the constellation, Anders Andersson (KD) stated in a debate over Socialutskottets Betänkande 2011/12:SoU26: “[W]e are moving towards a redefinition of the family concept that is not healthy” (Protokoll 2011/12:91). Constructing families in new constellations according to the preferences of involved adults where children are deprived of their origin is not the right way to go, he

20_{I have translated all statements into English, trying to change as little as possible. See References for Swedish}

titles and to find the original statements. Protokoll 2011/12:91 is found under References as “Riksdagens protokoll”.

21_{Socialdemokraterna.} 22_Folkpartiet.

23_{Which also involves emphasizing how children born through surrogacy might be caught up in conflicts}

between involved parties (Protokoll 2011/12:91).

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explains.

To illustrate an opposite standpoint, six members of the Green Party (MP)25_{, among them}

Gunvor G. Ericson and Thomas Nihlén, issued a private member’s bill in which they criticized the current legislation related to infertility as based on hetero-normative thinking. In relation to children, they ask the rhetoric question: ”Why would a child who obviously is so longed-for that the parents have gone through great inconvenience to get it have it worse off than a child that was not planned?” (Motion 2008/09:So559). What comes into question is consequently a right’s perspective of adults:

Society changes and so do people’s living conditions. When lesbian couples have been given equal opportunities to assisted reproduction as same-sex couples it can be plausible that also gay male couples have the opportunity to become biological parents. (Motion 2008/09:So559)

Surrogacy could thus be a help to those who wish to have a family that resembles the nuclear family, i.e. two parents and biological child(ren). Eva Olofsson, of the Left Party (V), criticizes how far people are willing to go – i.e. using a woman as a surrogate – in the quest for a genetically related child: ”It is not an Indian child living at an orphanage one is looking for, but a child that resembles oneself. (…) One wants a Western child” (Protokoll 2011/12:91). Striving for a genetic link becomes complicated in the case of surrogacy, but not when it comes to allowing single women insemination26. She continues: “Instead I believe that we should keep working for more guardians, more generous insemination rules and adoption rules that are more allowing (Socialutskottets betänkande 2011/12:SoU26: p. 22), something Carina Hägg, of the Social Democratic Party (S)27 has also encouraged as an alternative to surrogacy (Motion 2010/11:So296).

Many emphasize how times have changed, including SMER who elaborates on how new reproductive techniques can help the modern family, or person. SMER discusses research on family and states that the nuclear family is to a great extent ”a reality and an ideal” for many, but also bring up how ”instead of family one can talk about family practices that suggest that family is something that is being made28 and constantly changing, rather than something static and unchanged” (see discussion in 2013: 36). In other words, constructionist awareness is to a great extent present in the report and used as a guiding principle. Social factors, like safety and love (ibid.:136), are seen as more important than genetic connection for the well-being of

25_{Miljöpartiet.}

26_{Debated simultaneously as surrogacy.} 27_{Socialdemokraterna.}

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the child (SMER 2013: 20). Consequently, parenting is viewed from the perspective of what one does rather than what one is, echoing the theoretical perspectives brought forward by Giddens (1991) and Beck-Gernsheim & Beck (2002). Expressions of this are the opinions that donation of fertilized eggs should be allowed (SMER 2013: 136), women who want to freeze their eggs because of age related infertility should be able to do so29 (ibid: 21) and age30 should not determine who gets infertility treatment or not as people age individually (ibid.: 25). In comparison to the Christian Democrats, the council declares an acceptance over people’s ability to construct their reproduction to a greater extent. However, they carefully emphasize that ”(…) it cannot be a right of childless couples to have access to assisted reproduction” (ibid.: 116). What is of highest importance is the child’s best interest and children should have the right to know about their origin (ibid.: 125). In other words, although the parents might view biology as insignificant, the child might not.

5.1.2 Having children is no right – public questioning of the desires of the modern individual

And everything (…) exclusively in the intended parents’ interest: obedient31 references to the child’s best does not change the fact that it was hardly for the sake of children that the question was initiated. (Barometern 2013a32₎

Public discussions in the media share similarities to those expressed in the political debate. In relation to the statement made by SMER, many emphasize the positive aspects of surrogacy; in letting more couples have children and expanding the notion of family (see e.g. Helsingsborgs Dagblad 2013; Motala & Vadstena Tidning 2013; Ljusnan 2013; Öppna Moderater 2013). New reproductive techniques are seen as helpful to the “project” of the modern person:

We live in a time when family planning and family formation for many are the effects of own, free choices. It is a sign of freedom, life quality and humanity in development. That we within ethically acceptable frames try to support and help others to take part of the blessings of development is therefore both reasonable and relevant. (Södermanlands Nyheter 2013)

Few of those debaters who express an understanding of the difficulties involved in the longing for children and who are positive about surrogacy argue: ”having children is a right”, but

29_{Although at own cost.}

30_{They see it as inappropriate that general age limits decide who gets infertility treatment or not.} 31_{Pliktskyldiga.}

32_{When references are made to an editorial, the name of the paper is used. To other articles the name of the}

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several debaters have the opinion that people seem to think so and therefore argue: ”no one has a right to become a parent” (see e.g. Malin Wollin 2013; Claphaminstitutet 2013; Ingemar Kjellmer 2013)33. Similar ideas are expressed as in the political debate: children’s rights in general are often described as in opposition to the wishes of adults. Hanne Kjöller, editorial writer at Dagens Nyheter (DN), has made a few comments on the topic over the years. Partly by criticizing the way self-fulfilling and self-centered adults see themselves as having the right to a child of their own:

Children are viewed, not least among the middle class of the big cities, as the crowning glory34_{of an}

otherwise successful life (…) I believe that the fixation by the mother cult that we see today is at least partly about perfection and self-image rather than an actual longing to be close to a child. A lot of us have plenty of children around. And a lot of us have the possibilities to develop own relationships with some of them. But no, it’s not really the same. One wants a child of one’s own. (Dagens Nyheter 2013)

Having children as part of a self-expression rather than out of a wish to build a relationship with a child is illuminated as problematic. Why this is so could partly be related to how this

want is often connected to consumerism – and to how market forces sprung from the public

sphere have also come to dominate the private sphere. “Based on consumerism, new lifestyles seem to offer a wider-range of choices about how to live one’s life” (Chambers 2012: 35). Many of today’s self-expressions are created through consumption, and concepts from consumption discourses are often intertwined with discussions concerning why the modern individual chooses to have children:

The children who are to be born are sorted, planned and composed like never before. The gifts to the world and to the parents that children are, risk in the future to be increasingly more like specially ordered accessories. (Västerviks Tidningen 2012)

Children are (…) no right. The individualism and self-realization should not be driven so far that children and women’s bodies begin to be looked upon as commodities. (Gotlands Allehanda 2013).

Using the expression “children as commodities” quickly establishes surrogacy as a repellant practice. By appealing to cultural understandings of the separation between the market and more private spheres it clearly declares that what is for sale is family (Almeling 2011). Using rational concepts such as “sorted”, “planned” and “composed” also make the practice sound more like being about constructing a product rather than creating a child. Children should be

33_{Although not mentioned here, many politicians connected to the Christian Democrats have participated}

in the public debate with this argument.

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gifts and not products. However, as one debater, a mother to an adopted child, points out:

international adoption is also a form of trade with children and those being against commercial surrogacy should thus also object to the former. She continues “(…) that my husband and I were willing to pay 150 000 crowns to move a child from the other side of the earth was pure egoism” (Jenny Steen 2013). Hence, she helps to show how international adoption, an accepted practice in Sweden, can also be viewed from those perspectives from which commercial surrogacy is being criticized. The argument can be related to what Zelizer (2005) has pointed out: putting a price on something does not instantly turn it into a commodity, but one needs to pay attention to the context in which the transaction is carried out. However, some view adoption and surrogacy as different practices. The Christian Council of Sweden35 (SKR) emphasized: “To plan and systematically deprive children of the mother they have lived inside during nine months, who the child already has created a relation to intrauterine is something completely else” (SKR 2013). Likewise, a medical doctor against surrogacy explains: “It is an essential difference between taking care of a child that is already born, and taking responsibility for a life being created” (Ingemar Kjellmer 2013). In comparison to adoption, surrogacy arrangements have introduced “(…) a ‘custom-made’ market for children” (Zelizer 1988), which some debaters find more upsetting and also relate altruistic forms to. Other debaters emphasize how it is wrong to view childlessness as a consequence of personal priorities and chosen lifestyles that have gone wrong:

There is probably no other illness in Sweden that is as exposed to ignorance, marginalization and prejudice as involuntary childlessness. Within politics and health care the disease is lowly prioritized and in society there is a widespread view that it is not a “real” illness but a luxury problem. (Aleksander Giwercman et al 2013)

Through this perspective, the longing for children becomes portrayed as an illness rather than just another self-expression and becomes placed within a discourse far from consumption. 5.1.3 Why not co-operate instead of surrogacy?

In the theoretical section, I brought up how family patterns have changed during the last couples of decades (see e.g. Mills & Blossfeld 2013). One aspect that has not changed, though, is how people in general want to pair up with one other person and have a child together. This has been questioned as problematic in relation to surrogacy. E.g. Hanne Kjöller questioned the right of men to choose to remove the mother from the picture instead of co-operating (Dagens Nyheter 2011). Katrine Kielos writes in an editorial:

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In Sweden RFSL36_{raises the question as a solution for HBT-couples to have children. And one can}

wonder why it is so important to do this without the woman who has carried it also becoming a guardian. Is it so fundamental to imitate a conservative two-togetherness norm37_{? Is not a better}

solution that we for example open up for further guardians? (Aftonbladet 2012)

Maria Haldesten, editorial writer at Göteborgs Posten (GP) who has been engaged in the surrogacy debate over the years with a critical stance, also advocates more gay couples co-operating in the family makings: “(…) their children do not have to ponder one second on their genetic origin” (Göteborgs Posten 2011). Petra Östergren challenges the emphasis on how it is problematic to deprive children of their mother by stating:

(…) more people should have tried to exchange the criticism against surrogate motherhood with insemination and wondered why we have a society that allows men to be used as “breeding bulls38_”,

why lesbian families are allowed to exist when they can be said to “be characterized by the demand” of an absent father. (Petra Östergren 2010)

The demand can thus be criticized from the opposite direction as well39, and this gender analysis points to how it is culturally easier to exclude the father than the mother from the family making. Two members of Moderatmännen, Urban Johansson and Sten Holmström, who advocate an introduction of surrogacy in Sweden, also emphasize unequal consequences relating to the status of the mother. Apart from pointing out that adoption is not practically possible for gay men, they emphasize that earlier parenthood arrangements between gay men and lesbians have started to become phased out, as women have access to insemination either in Sweden or by going abroad. Moreover, they declare that many feel insecure in making those type of arrangements as mothers are often favored if there would ever be a custody battle, rendering surrogacy as a safer alternative. In the same vein as several politicians have argued, they state that it is about time to broaden the possibilities to parenthood for all citizens. Reproduction thus becomes a question of equality that the state should help in securing: gay men and men in general should also be granted rights to parenthood (Moderatmännen 2010). A parallel can thus be made to the Volden-case in Norway (see p. 11 and p. 13-14 or Andersen 2013) and the expectations on the welfare state to help in the family making. Surrogacy is to a great extent an HBTQ issue, however not solely, and politicians as

36_{Riksförbundet för homosexuellas, bisexuellas, transpersoners och queeras rättigheter (The Swedish}

Federation for Lesbian, Gay, Bisexual and Transgender Rights).

37_{Tvåsamhetsnorm.} 38_Avelstjurar.

39_{The Christian Democrats have argued against allowing insemination for single women in Sweden from}

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well as debaters emphasize that it is mostly heterosexual couples who hire surrogate mothers. This way, it is pointed out that it is not about the Swedish state not granting homosexual men the right to parenthood, but has to be viewed from a greater perspective.

5.1.4 The bond between mother and child

By looking at the political debate over the years, it is possible to see that motherhood per se or what it constitutes is seldom problematized. The only party to express opinions on this matter is the Christian Democrats, although there is a widespread opinion that it is important that the child gets to know about those parties who have been involved in its conception. The disruption of the bond between the gestational mother and the child is questioned to a greater extent in other parts of the public debate, although a minority in SMER also raised it as one argument to why surrogacy should not be allowed (SMER 2013: 175). While some debaters argue: “We should (…) open up for broader families where one for example out of solidarity can give birth to the child of one’s friends without being the child’s biological parents” (RFSL Ungdom40 2010), others argue that pregnancy is different from just a production technology. Partly by pointing to the fact that there is not enough knowledge about what it means for a fetus to be carried by someone who does not want to or has the ability to connect to it, or how newborn children or surrogate mothers are affected by being separated from one another right after birth (see e.g. Göteborgs Posten 2010, Margareta Viberg 2013, Sveriges Kristna Råd 2013).

Helena Granström, who has written the novel Hysteros, dealing with pregnancy, writes in an article: ”If we are not able to formulate better arguments against surrogate motherhood than how socially exposed women risk economic exploitation, we have a very frail foundation to problematize a literate mechanization of pregnancy” (Granström 2013). Problematic, according to her, is instead the denial of the relationship that is built between the carrying mother and the growing child.

What is a pregnancy? If the answer is growth, supply of nutrition and regulation of temperature during nine months the question is just as easy as RFSL and others want it to be: a child should be produced, and from its perspective the conditions of production are insignificant, as long as they fulfill the technical specification. (ibid.)

In the Swedish public debate, surrogacy is often problematized from the perspective of the circumstances that surround it, which I will delve deeper into later in the analysis. Granström

Giving Birth

Giving Birth

Debating Surrogate Motherhood in Sweden, A

Question of Equality

Abstract

Contents

1. Introduction

1.1 Purpose and research questions

1.2 Limitation of study

1.3 Outline of paper

2. Background

2.1 What is surrogacy?

2.2 Legislation in Sweden and abroad

3. Theoretical framework and

previous research

3.1 Social conflicts and problems: The battle of

values, interests and classification schemes

3.2 What is a mother?

3.3

Changing

structures

and

values:

understanding

contemporary

families

and

individuals

3.4 Debating unequal circumstances: exploitation

or denied self-determination?

3.5 Commodification: discussing exploitation of

humanity and presenting counterarguments

4. Methodology

4.1 What material to use and why?

4.2 Access and selection

4.3 Coding and analysis

4.4.

Ethics:

the

researcher’s

impact

and

responsibility

5. Analysis & Results

5.1 Debating family